Pitfalls in terminating a patient relationship

Physicians sometimes face the prospect of dismissing patients from their practice. It’s not easy, but there is a right way and a wrong way to do it.  

Termination guidelines

A physician is generally permitted to terminate his or her relationship with a patient, but must comply with certain ethical and legal guidelines in doing so. The termination cannot be based on age, color, disability, gender, national origin, religion, sexual orientation or any other discriminatory reason. A physician cannot terminate a patient relationship in a manner that would be deemed an abandonment of the patient or neglect of patient care. There needs to be some assurance of continuity of care.

  What to do before terminating

Prior to terminating the relationship, a physician may want to consider speaking with the patient to the extent that the issue involved can be resolved (e.g.,failure to pay a bill.) It would be prudent to conduct any such discussion with a member of the physician’s staff present and to contemporaneously document the discussions by a memo to the files of the practice.

  Assuring continuity of care

With respect to continuity of care issues, the physician first needs to determine whether the treatment has reached a stage where the physician can safely end his or her oversight of the patient. For example, if a patient recently had been operated by the physician, or if the patient is pregnant with a due date that is near, the physician needs to consider whether terminating the relationship at that time would be in the best interests of the patient.

  Check the payer contract

Read payer fine print. If the patient is covered by a plan in which the physician participates, the physician needs to review the agreement to confirm that the plan does not restrict his or her ability to end the patient relationship, or that the plan does not include additional requirements prior to taking such a step.